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目的:探讨胃癌术中前哨淋巴结(sentinel lymph node,SLN)定位检测的可行性及其临床意义。方法:使用亚甲蓝对40例胃癌患者行前哨淋巴结术中标识活检,随后行D2或D2以上手术。结果:40例胃癌患者中,38例找到前哨淋巴结,检出率为38/40(95%),有32例存在SLN转移,8例SLN为唯一转移部位,且均为T1、T2期。由SLN的病理学状态来预测胃周围淋巴结转移情况的敏感性为32/34(94.12%),特异性为4/4(100%),假阴性率为2/34(5.88%),准确率为34/38(89.47%),其中假阴性的2例,肿瘤都处于T4期。结论:胃癌SLN定位及活检技术能较准确反映早期胃癌的淋巴结转移状况,但对进展期胃癌而言假阴性率较高,对胃癌整个区域淋巴结状态预测的可靠性和可行性尚需进一步验证。
Objective: To investigate the feasibility and clinical significance of localization of sentinel lymph node (SLN) in gastric cancer. Methods: 40 patients with gastric cancer were treated with methylene blue for sentinel lymph node biopsy, followed by D2 or D2 surgery. Results: Of the 40 gastric cancer patients, 38 sentinel lymph nodes were found, the detection rate was 38/40 (95%). There were 32 cases with SLN metastasis and 8 cases with SLN as the only metastatic site, both of which were T1 and T2. The sensitivity of SLN pathology to predict gastric peripheral lymph node metastasis was 32/34 (94.12%), specificity was 4/4 (100%), false negative rate was 2/34 (5.88%), accuracy 34/38 (89.47%), of which 2 cases of false negative, the tumor is in T4 period. Conclusion: SLN localization and biopsy of gastric cancer can accurately reflect the status of lymph node metastasis of early gastric cancer, but the false negative rate is high for advanced gastric cancer. The reliability and feasibility of predicting the status of lymph node in gastric cancer need to be further verified.